Strategies for promoting judicious use of antibiotics by doctors and patients
Strategies for promoting judicious use of antibiotics by doctors and patients
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DOI：
10.1136/bmj.317.7159.668
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发表时间：
1998-09-05
影响因子：
--
通讯作者：
Schwartz, B
中科院分区：
文献类型：
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作者：
Belongia, EA;Schwartz, B
最近使用抗生素是一个有充分证据的感染或定居耐药病原体的风险因素。1-7尽管承认了这一点，但不必要的抗生素处方仍然很常见。在美国，超过五分之一的儿童和成人抗生素处方是针对上呼吸道感染或支气管炎开的，这些疾病几乎总是通过病毒传播。英国也出现了类似的不必要抗生素使用率。10这些发现与医生焦点小组的结果一致，在这些小组中，参与者估计10%到50%的门诊抗生素处方是不必要的。11只有有限的数据可以用来评估减少抗生素处方是否会减少耐药性的传播。在芬兰，在一场成功的减少大环内酯类抗生素使用的运动之后，对大环内酯类抗生素耐药的A组链球菌感染的比例几乎减半。12冰岛的一项横断面调查发现，青霉素耐药肺炎球菌的携带与个人和整个社区的抗菌剂使用水平密切相关，13而且有一些证据表明，干预方案降低了青霉素耐药菌株引起的肺炎球菌感染的比例。14.
Recent antibiotic use is a well documented risk factor for infection or colonisation with resistant pathogens. 1–7 Despite this recognition, unnecessary antibiotic prescribing remains common. In the United States more than a fifth of all antibiotic prescriptions for children and adults are written for upper respiratory tract infections or bronchitis, conditions that are almost always viral. 8 9 Similar rates of unnecessary antibiotic use have been described in Britain. 10 These findings are consistent with results from focus groups among doctors, in which participants have estimated that 10% to 50% of outpatient antibiotic prescriptions are unnecessary. 11 Only limited data are available to evaluate whether reducing antibiotic prescribing will reduce the spread of resistance. In Finland the proportion of group A streptococcal infections resistant to macrolides was nearly halved after a successful campaign to reduce the use of macrolide antibiotics. 12 A cross sectional survey in Iceland found that carriage of penicillin resistant pneumococci was strongly associated with both individual and community-wide levels of antimicrobial use, 13 and there is some evidence that an intervention programme has decreased the proportion of pneumococcal infections caused by penicillin resistant strains. 14